Form I-824 Application for Action on an Approved Application

OMB No. 1615-0044: Expires 08/31/09

I-824, Application for Action on an
Approved Application or Petition

Department of Homeland Security
U.S. Citizenship and Immigration Services

START HERE - Please type or print in black ink

Part 1. Information About You (Person filing this application)

Returned

Family Name (Last name)

Date

Given Name (First name)

Middle Name

For USCIS Use Only
Receipt

Date
Resubmitted

Company or Organization Name
Home or Business Address - Street Number and Name
City

State or Province

Zip/Postal Code

Country

Mailing Address - Street Number and Name

Apt./Suite #

Date
Date
Reloc Sent
Date

Apt./Suite #

Date
Reloc Rec'd
Date

C/O (In care of):

Date

City

State or Province

Zip/Postal Code

Country

Remarks

Daytime Phone # (Area/country codes)
Country of Birth

Country of Citizenship

Date of Birth (mm/dd/yyyy)

IRS Tax # (If any)

A # (If any)

U.S. Social Security # (If any)

Action Block

Part 2. Reason for Request
I am requesting (Check one box):
A.

A duplicate approval notice

B.

USCIS to notify a new U.S. Consulate, different from that originally requested, through the
U.S. Department of State's National Visa Center or Kentucky Consular Center about the
approval of a nonimmigrant visa petition or to notify a new Port-of-Entry, different from that
originally requested, about the approval of a waiver application. Please notify the U.S.
Consulate or Port-of-Entry at:

C.

D.
E.

USCIS to notify a U.S. Consulate through the National Visa Center that my status has been
adjusted to permanent resident based on an approved I-485 application. Please notify the U.S.
Consulate at:

To Be Completed by
Attorney or Representative, if any.
Fill in box if G-28 is attached to
represent the applicant.
ATTY State License #

USCIS to send my approved immigrant visa petition to the National Visa Center (NVC)
USCIS to notify the U.S. Department of State of my U.S. Citizenship status
Form I-824 (Rev. 08/25/08) Y

Part 3. Additional Information
1. Give the following information about the original petition or application.
Type of Petition or Application (Form number)
Receipt Number (On Form I-797, Notice of Action)
Filing Date of Petition or Application (mm/dd/yyyy)

Approval Date (mm/dd/yyyy)

2. Give the following information about the petitioner or applicant for the original petition or application.
Current/Most Recent Immigration Status
Naturalization/Citizenship Certificate Number
3. Give the following information about the principal beneficiary of the original petition or application.
Middle Name
Family Name (Last name)
Given Name (First name)
Date of Birth (mm/dd/yyyy)

A # (If any)

Country of Birth

Home Address - Street Number and Name
City

Apt. #

State or Province

Zip/Postal Code

Mailing Address - (If different from home address)
Street Number and Name/P.O. Box Number
City

State or Province

Country

C/O (In care of)
Zip/Postal Code

Country

Daytime Phone (Area/country code and number)
4. If you have checked box C in Part 2, give the following information about the dependents(s) for whom you are requesting
following-to-join. If you need additional space, attach a separate sheet(s) of paper.
Family Name (Last name)
Relationship to the Principal Alien

Given Name (First name)

Foreign Address

Middle Name
Foreign Telephone Number

Form I-824 (Rev. 08/25/08) Y Page 2

Part 4. Signature (Read the information on penalties in the instructions before completing this part.)
I certify, under penalty of perjury under the laws of the United States of America, that this information and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
Signature
Daytime Phone Number (With area code)
Date (mm/dd/yyyy)
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be
found eligible for the requested benefit and this application may be denied.

Part 5. Signature of Person Preparing Form, if Other than Above (Sign below)
I declare that I prepared this at the request of the applicant and it is based on all information of which I have knowledge.
Print or Type Your Name
Signature
Firm Name and Address

Date (mm/dd/yyyy)

E-Mail Address (If any)

Daytime Phone Number (With area code)

Form I-824 (Rev. 08/25/08) Y Page 3